Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 35048745 | OH |
Y | 111NI0900X | Internist | 35048745 | OH |
N | 207RA0401X | Internist - Addiction Medicine | 35048745 | OH |
N | 207RG0300X | Geriatric Medicine | 35048745 | OH |
NPI | 1083696371 |
---|---|
Provider Name | Dr. Douglas W Teller |
First Address | Miamisburg, OH 45342-3600 |
Second Address | Miamisburg, OH 45342-3600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2005 |
Last Update Date | 18/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000330888 | ANTHEM (01) | |
016801000 | MAGELLAN (01) | |
0664311 | (05) | OH |
C03396 | (02) |